Forum topic

 The ugly truth is that all the caps work better than relying on clinicians to swab the cap with an alcohol wipe.  No perfect answer here but reality is reality.  I like the Curos personally, more secure.

First let me say that I am a paid consultant for Excelsior Medical, the manufacturer of SwabCap. I don't think any of the 3 protective caps make the claim that they provide a sterile connection surface on the needleless connector. And you are correct that alcohol does not kill every organism. If you have any question about the integrity of the system, then by all means, you can and should manually clean with an alcohol pad before connection. SwabCap data shows that it is effective for up to 96 hours. This is probably because the design prevents the alcohol from drying out. It remains wet, therefore remains effective. You should also manually clean the connection surface with each subsequent connection. SASH requires 4 connections and disconnections, so with the SwabCap this would require cleaning with an alcohol pad because there could be blood-tinged fluid left on the surface after disconnection, or the intermittent set lying in the bed for 1 hour during infusion could allow more organisms and debris to attach. The fact is that this protective device is proving to be more beneficial that manual cleaning. At the recent APIC conference there was a poster presentation from an IL hospital. They pulled blood for culture from PICCs every day before starting to use SwabCap. Then began SwabCap use and continued to obtain these culture samples. The number of organisms from these cultures was far less with the SwabCap than without it. This study is moving into the 3rd phase where they will stop SwabCap use and continue to culture each day. Then they plan to publish these results. Manual cleaning is just not enough. Another recent study found that longer cleaning (15 sec) is better than shorter periods but even that does not remove all organisms. Lynn

There is no substitute for friction.  I am a firm believer you must scrub the access site before entry period regardless of which product is used as a disinfecting cap.

Are we to teach an entire generation of "RN's" not to scrub the access site anymore?  How does one use a disinfecting cap in the ER, anesthesia, code, recovery room when one must wait five minutes for the action of the disinfecting cap?  This means we teach those departments to scrub the access sites and those with disinfecting caps that scrubbing is not needed.  Mixed messages do not work well with standarized care.

I personally go with the CDC 2011 on this one.  Scrub the access site,  If you use a cap you must still teach scrub the access site.

Friction is not passee and hopefully unless some product performs the friction for the caregiver I do not see it disappearing or maybe it is disappearing right before my eyes.

Personally I have a bias as Bard Access makes a product to scrub the access site.  In no way am I pushing the Bard product.  There are many ways to scrub an access site and one of them has been the alcohol swabs for decades.  I suggest not teaching an entire generation of RN's that scrubbing and friction is outdated.  What is the impact of that change?

Kathy Kokotis

Kathy, none of these products was included in the CDC guidelines in any way. I am referring to the Bard scrubbing device or to the 3 brands of protective caps available. There were no studies on any of these devices, therefore the CDC guidelines are silent on their use. It is my understanding that there were numerous discussions about the language for this section of the guidelines and they finally settled on changing the word "wipe" for "scrub". It is also important to note that they did not include any length of time for scrubbing. This was because the data in only from in vitro studies and there are no studies that have documented a decrease in CLABSI rates with various lengths of scrubbing time. c

No one is saying that scrubbing should not occur if the catheter has not had a protection cap on it, or if the integrity of the cap is in question. Obviously, nurses can and do use critical thinking skills for these situations. There is some in vitro evidence that scrubbing even for 15 seconds will not remove all organisms. See http://journals.lww.com/ccnq/Abstract/2011/01000/_Scrub_the_Hub___Cleani...

Lynn